1689868010 NPI number — PRIME HEALTHCARE PARADISE VALLEY HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689868010 NPI number — PRIME HEALTHCARE PARADISE VALLEY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIME HEALTHCARE PARADISE VALLEY HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689868010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 MOSS ST
Provider Second Line Business Mailing Address:
490 EMORY, IMPERIAL BEACH, CA. 91932
Provider Business Mailing Address City Name:
CHULA VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91911-2005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-585-4228
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 RIMBEY AVENUE
Provider Second Line Business Practice Location Address:
CLASS ROOM #27
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92154-3099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-628-3541
Provider Business Practice Location Address Fax Number:
619-628-3589
Provider Enumeration Date:
08/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HANLY
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
619-470-4233

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , with the licence number:  090000086 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 37JW , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 37JW . This is a "COUNTY OF SAN DIEGO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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